certifyos - Director of Quality

• A genuine obsession with quality in data, in work, and in outcomes: you notice what is slightly off, you cannot leave it alone, and leaders and clients trust you to say whether the work is right. • A record of driving quality at scale. You have built the measurement, audit, and feedback systems that moved error rates in a high-volume operation, and you can show the before and after. • Strongly data-driven: you find root causes with data, design sampling and scoring, build and use dashboards, and make decisions on numbers rather than anecdotes. • Deep credentialing expertise: you know how a provider file is built, verified, and committee-reviewed, including primary source verification, recredentialing cycles, and the common failure modes in each. • Experience running an audit or QA function at production scale, including sampling, scoring, calibration, and root cause analysis. • Enough technical fluency to work with Product and Engineering: you can read a workflow, write a clear requirement, and judge what automation or system controls can do. • 10+ years in healthcare operations, quality, or compliance, including 5+ years leading teams, with direct ownership of throughput and turnaround-time targets. • Hands-on knowledge of NCQA credentialing standards and how they are audited, ideally from having led or supported a certification or delegation audit. • Experience with delegation from either side: overseeing delegates at a health plan, or being overseen as a delegated credentialing organization or CVO. • Executive presence: comfortable presenting to health plan compliance officers and senior client leaders, and holding your ground on interpretation of a standard. • Strong written and verbal communication, and the judgment to escalate the right issues early. • Prior experience at a credentialing verification organization (CVO), a delegated health plan credentialing department, or a credentialing technology company. • NCQA experience beyond credentialing, such as provider network management or utilization management standards. • Familiarity with URAC, The Joint Commission, CMS, and state credentialing requirements, and with SOC 2 or HITRUST audits. • Experience using data tools to monitor quality, such as SQL, BI dashboards, or workflow analytics. • Experience in a scaling startup where processes were being built as the company grew.